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Verduzco-Gutierrez M, Raghavan P, Pruente J, Moon D, List CM, Hornyak JE, Gul F, Deshpande S, Biffl S, Al Lawati Z, Alfaro A. AAPM&R consensus guidance on spasticity assessment and management. PM R 2024. [PMID: 38770827 DOI: 10.1002/pmrj.13211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/19/2024] [Accepted: 04/08/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The American Academy of Physical Medicine and Rehabilitation (AAPM&R) conducted a comprehensive review in 2021 to identify opportunities for enhancing the care of adult and pediatric patients with spasticity. A technical expert panel (TEP) was convened to develop consensus-based practice recommendations aimed at addressing gaps in spasticity care. OBJECTIVE To develop consensus-based practice recommendations to identify and address gaps in spasticity care. METHODS The Spasticity TEP engaged in a 16-month virtual meeting process, focusing on formulating search terms, refining research questions, and conducting a structured evidence review. Evidence quality was assessed by the AAPM&R Evidence, Quality and Performance Committee (EQPC), and a modified Delphi process was employed to achieve consensus on recommendation statements and evidence grading. The Strength of Recommendation Taxonomy (SORT) guided the rating of individual studies and the strength of recommendations. RESULTS The TEP approved five recommendations for spasticity management and five best practices for assessment and management, with one recommendation unable to be graded due to evidence limitations. Best practices were defined as widely accepted components of care, while recommendations required structured evidence reviews and grading. The consensus guidance statement represents current best practices and evidence-based treatment options, intended for use by PM&R physicians caring for patients with spasticity. CONCLUSION This consensus guidance provides clinicians with practical recommendations for spasticity assessment and management based on the best available evidence and expert opinion. Clinical judgment should be exercised, and recommendations tailored to individual patient needs, preferences, and risk profiles. The accompanying table summarizes the best practice recommendations for spasticity assessment and management, reflecting principles with little controversy in care delivery.
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Affiliation(s)
- Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessica Pruente
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Moon
- Department of Physical Medicine and Rehabilitation, Jefferson Moss-Magee Rehabilitation Hospital, Elkins Park, Pennsylvania, USA
| | | | - Joseph Edward Hornyak
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Fatma Gul
- Department of Physical Medicine and Rehabilitation Department, University of Texas, Southwestern Medical Center, Dallas, Texas, USA
| | - Supreet Deshpande
- Department of Pediatric Rehabilitation Medicine, Gillette Children's Hospital, St.Paul, Minnesota, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Susan Biffl
- Division Pediatric Rehabilitation Medicine Department of Orthopedic Surgery, UCSD Rady Children's Hospital, San Diego, California, USA
| | - Zainab Al Lawati
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Abraham Alfaro
- Rehabilitation Medicine, AtlantiCare Health Services, Inc., Federally Qualified Health Center (FQHC), Atlantic City, New Jersey, USA
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Papagiannis G, Triantafyllou Α, Yiannopoulou KG, Georgoudis G, Kyriakidou M, Gkrilias P, Skouras AZ, Bega X, Stasinopoulos D, Matsopoulos G, Syringas P, Tselikas N, Zestas O, Potsika V, Pardalis A, Papaioannou C, Protopappas V, Malizos N, Tachos N, Fotiadis DI. Ηand dexterities assessment in stroke patients based on augmented reality and machine learning through a box and block test. Sci Rep 2024; 14:10598. [PMID: 38719940 PMCID: PMC11079036 DOI: 10.1038/s41598-024-61070-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
A popular and widely suggested measure for assessing unilateral hand motor skills in stroke patients is the box and block test (BBT). Our study aimed to create an augmented reality enhanced version of the BBT (AR-BBT) and evaluate its correlation to the original BBT for stroke patients. Following G-power analysis, clinical examination, and inclusion-exclusion criteria, 31 stroke patients were included in this study. AR-BBT was developed using the Open Source Computer Vision Library (OpenCV). The MediaPipe's hand tracking library uses a palm and a hand landmark machine learning model to detect and track hands. A computer and a depth camera were employed in the clinical evaluation of AR-BBT following the principles of traditional BBT. A strong correlation was achieved between the number of blocks moved in the BBT and the AR-BBT on the hemiplegic side (Pearson correlation = 0.918) and a positive statistically significant correlation (p = 0.000008). The conventional BBT is currently the preferred assessment method. However, our approach offers an advantage, as it suggests that an AR-BBT solution could remotely monitor the assessment of a home-based rehabilitation program and provide additional hand kinematic information for hand dexterities in AR environment conditions. Furthermore, it employs minimal hardware equipment.
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Grants
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- Τ2ΕΔΚ04333 European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH-CREATE- INNOVATE
- European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship, and Innovation, under the call RESEARCH–CREATE– INNOVATE
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Affiliation(s)
- Georgios Papagiannis
- Biomechanics Laboratory, Physiotherapy Department, University of the Peloponnese, 23100, Sparta, Greece.
- Physioloft, Physiotherapy Center, 14562, Kifisia, Greece.
| | - Αthanasios Triantafyllou
- Biomechanics Laboratory, Physiotherapy Department, University of the Peloponnese, 23100, Sparta, Greece
- Physioloft, Physiotherapy Center, 14562, Kifisia, Greece
| | | | - George Georgoudis
- Department of Physiotherapy, University of West Attica, 12243, Athens, Greece
| | - Maria Kyriakidou
- Biomechanics Laboratory, Physiotherapy Department, University of the Peloponnese, 23100, Sparta, Greece
| | - Panagiotis Gkrilias
- Biomechanics Laboratory, Physiotherapy Department, University of the Peloponnese, 23100, Sparta, Greece
| | - Apostolos Z Skouras
- Sports Excellence, 1St Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Xhoi Bega
- Physioloft, Physiotherapy Center, 14562, Kifisia, Greece
| | | | - George Matsopoulos
- Biomedical Engineering Laboratory, National Technical University of Athens, 9, Herοon Polytechniou Str., Zografou, 15773, Athens, Greece
| | - Pantelis Syringas
- Biomedical Engineering Laboratory, National Technical University of Athens, 9, Herοon Polytechniou Str., Zografou, 15773, Athens, Greece
| | - Nikolaos Tselikas
- CNA Lab, Department of Informatics, Telecommunications University of Peloponnese, 22100, Tripoli, Greece
| | - Orestis Zestas
- CNA Lab, Department of Informatics, Telecommunications University of Peloponnese, 22100, Tripoli, Greece
| | - Vassiliki Potsika
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, 45110, Ioannina, Greece
| | - Athanasios Pardalis
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, 45110, Ioannina, Greece
| | - Christoforos Papaioannou
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, 45110, Ioannina, Greece
| | | | | | - Nikolaos Tachos
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, 45110, Ioannina, Greece
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, 45110, Ioannina, Greece
- Biomedical Research Institute, Foundation for Research and Technology-Hellas (FORTH), 70013, Heraklion, Greece
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Lu Z, Zhang Y, Li S, Zhou P. Botulinum toxin treatment may improve myoelectric pattern recognition in robot-assisted stroke rehabilitation. Front Neurosci 2024; 18:1364214. [PMID: 38486973 PMCID: PMC10937383 DOI: 10.3389/fnins.2024.1364214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Affiliation(s)
- Zhiyuan Lu
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Yingchun Zhang
- Department of Biomedical Engineering, Desai Sethi Urology Institute, Miami Project to Cure Paralysis, University of Miami, Coral Gables, FL, United States
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Ping Zhou
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
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Rissardo JP, Byroju VV, Mukkamalla S, Caprara ALF. A Narrative Review of Stroke of Cortical Hand Knob Area. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:318. [PMID: 38399606 PMCID: PMC10890039 DOI: 10.3390/medicina60020318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
The cortical hand knob region of the brain is a knob-like segment of the precentral gyrus, projecting into the middle genu of the central sulcus. This anatomic landmark is responsible for intricate control of hand motor movements and has often been implicated in motor weakness following stroke. In some instances, damage to this area has been mistaken for peripheral causes of hand weakness. Our article aims to consolidate clinically relevant information on the cortical hand knob area in a comprehensive review to guide clinicians regarding diagnosis and treatment strategies. We conducted a systematic search within the Medline/PubMed database for reports of strokes in the cortical hand knob region. All studies were published electronically up until December 2023. The search was conducted using the keyword "hand knob". A total of 24 reports containing 150 patients were found. The mean and median ages were 65 and 67 years, respectively. Sixty-two percent of the individuals were male. According to the TOAST criteria for the classification of the stroke, 59 individuals had a stroke due to large-artery atherosclerosis, 8 had small-vessel occlusion, 20 had cardioembolism, 25 were determined, and 38 were undetermined. The most common etiologies for stroke in the hand knob area can be attributed to large vessel occlusions, small vessel occlusions, or cardioembolism. Presentations following damage to this area can mimic ulnar, median, or radial neuropathy as well. Our comprehensive review serves as a resource for recognizing and managing stroke in the cortical hand knob area.
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Affiliation(s)
- Jamir Pitton Rissardo
- Neurology Department, Cooper University Hospital, Camden, NJ 08103, USA; (J.P.R.); (V.V.B.)
| | - Vishnu Vardhan Byroju
- Neurology Department, Cooper University Hospital, Camden, NJ 08103, USA; (J.P.R.); (V.V.B.)
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Huang L, Yi L, Huang H, Zhan S, Chen R, Yue Z. Corticospinal tract: a new hope for the treatment of post-stroke spasticity. Acta Neurol Belg 2024; 124:25-36. [PMID: 37704780 PMCID: PMC10874326 DOI: 10.1007/s13760-023-02377-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
Stroke is the third leading cause of death and disability worldwide. Post-stroke spasticity (PSS) is the most common complication of stroke but represents only one of the many manifestations of upper motor neuron syndrome. As an upper motor neuron, the corticospinal tract (CST) is the only direct descending motor pathway that innervates the spinal motor neurons and is closely related to the recovery of limb function in patients with PSS. Therefore, promoting axonal remodeling in the CST may help identify new therapeutic strategies for PSS. In this review, we outline the pathological mechanisms of PSS, specifically their relationship with CST, and therapeutic strategies for axonal regeneration of the CST after stroke. We found it to be closely associated with astroglial scarring produced by astrocyte activation and its secretion of neurotrophic factors, mainly after the onset of cerebral ischemia. We hope that this review offers insight into the relationship between CST and PSS and provides a basis for further studies.
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Affiliation(s)
- Linxing Huang
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Lizhen Yi
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Huiyuan Huang
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Sheng Zhan
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Ruixue Chen
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Zenghui Yue
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China.
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Valenzuela-López L, Moreno-Verdú M, Cuenca-Zaldívar JN, Romero JP. Effects of Hand Motor Interventions on Cognitive Outcomes Post-stroke: A Systematic Review and Bayesian Network Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)00029-7. [PMID: 38211761 DOI: 10.1016/j.apmr.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/29/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To synthetize the evidence on the effects of hand rehabilitation (RHB) interventions on cognition post-stroke and compare their efficacy. DATA SOURCES PubMed, Embase, Cochrane, Scopus, Web of Science, and CINAHL were searched from inception to November 2022. DATA SELECTION Randomized controlled trials conducted in adults with stroke where the effects of hand motor interventions on any cognitive domains were assessed. DATA EXTRACTION Data were extracted by 2 independent reviewers. A Bayesian Network Meta-analysis (NMA) was applied for measures with enough studies and comparisons. Risk of bias was assessed with the Cochrane Risk of Bias tool. DATA SYNTHESIS Fifteen studies were included in qualitative synthesis, and 11 in NMA. Virtual reality (VR) (n=7), robot-assisted (n=5), or handgrip strength (n=3) training were the experimental interventions and conventional RHB (n=14) control intervention. Two separate NMA were performed with MoCA (n=480 participants) and MMSE (n=350 participants) as outcome measures. Both coincided that the most probable best interventions were robot-assisted and strength training, according to SUCRA and rankogram, followed by conventional RHB and VR training. No significant differences between any of the treatments were found in the MoCA network, but in the MMSE, robot-assisted and strength training were significantly better than conventional RHB and VR. No significant differences between robot-assisted and strength training were found nor between conventional RHB and VR. CONCLUSIONS Motor interventions can improve MoCA/MMSE scores post-stroke. Most probable best interventions were robot-assisted and strength training. Limited literature assessing domain-specific cognitive effects was found.
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Affiliation(s)
- Laura Valenzuela-López
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain
| | - Marcos Moreno-Verdú
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain.
| | - Juan Nicolás Cuenca-Zaldívar
- Research Group in Physiotherapy and Pain, Department of Nursing and Physiotherapy, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain; Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute - Segovia de Arana (IDIPHISA), Madrid, Spain; Physical Therapy Unit. Primary Health Care Center "El Abajón", Madrid, Spain; Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Juan Pablo Romero
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Damage Unit, Beata María Ana Hospital, Madrid, Spain
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Adeel M, Peng CW, Lee IJ, Lin BS. Prediction of Spasticity through Upper Limb Active Range of Motion in Stroke Survivors: A Generalized Estimating Equation Model. Bioengineering (Basel) 2023; 10:1273. [PMID: 38002397 PMCID: PMC10669379 DOI: 10.3390/bioengineering10111273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND We aim to study the association between spasticity and active range of motion (ROM) during four repetitive functional tasks such as cone stacking (CS), fast flexion-extension (FFE), fast ball squeezing (FBS), and slow ball squeezing (SBS), and predicted spasticity models. METHODS An experimental study with control and stroke groups was conducted in a Medical Center. A total of sixty-four participants, including healthy control (n = 22; average age (years) = 54.68 ± 9.63; male/female = 12/10) and chronic stroke survivors (n = 42; average age = 56.83 ± 11.74; male/female = 32/10) were recruited. We employed a previously developed smart glove device mounted with multiple inertial measurement unit (IMU) sensors on the upper limbs of healthy and chronic stroke individuals. The recorded ROMs were used to predict subjective spasticity through generalized estimating equations (GEE) for the affected side. RESULTS The models have significant (p ≤ 0.05 *) prediction of spasticity for the elbow, thumb, index, middle, ring, and little fingers. Overall, during SBS and FFE activities, the maximum number of upper limb joints attained the greater average ROMs. For large joints, the elbow during CS and the wrist during FFE have the highest average ROMs, but smaller joints and the wrist have covered the highest average ROMs during FFE, FBS, and SBS activities. CONCLUSIONS Thus, it is concluded that CS can be used for spasticity assessment of the elbow, FFE for the wrist, and SBS, FFE, and FBS activities for the thumb and finger joints in chronic stroke survivors.
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Affiliation(s)
- Muhammad Adeel
- The Master Program in Smart Healthcare Management, International College of Sustainability Innovations, National Taipei University, New Taipei City 237303, Taiwan;
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan;
| | - Chih-Wei Peng
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan;
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan
| | - I-Jung Lee
- College of Electrical Engineering and Computer Science, National Taipei University, New Taipei City 237303, Taiwan;
| | - Bor-Shing Lin
- Department of Computer Science and Information Engineering, National Taipei University, New Taipei City 237303, Taiwan
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Cho MJ, Yeo SS, Lee SJ, Jang SH. Correlation between spasticity and corticospinal/corticoreticular tract status in stroke patients after early stage. Medicine (Baltimore) 2023; 102:e33604. [PMID: 37115067 PMCID: PMC10145725 DOI: 10.1097/md.0000000000033604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/23/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
We investigated the correlation between spasticity and the states of the corticospinal tract (CST) and corticoreticular tract (CRT) in stroke patients after early stage. Thirty-eight stroke patients and 26 healthy control subjects were recruited. The modified Ashworth scale (MAS) scale after the early stage (more than 1 month after onset) was used to determine the spasticity state of the stroke patients. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), fiber number (FN), and ipsilesional/contra-lesional ratios for diffusion tensor tractography (DTT) parameters of the CST and CRT after the early stage were measured in both ipsi- and contra-lesional hemispheres. This study was conducted retrospectively. The FA and FN CST-ratios in the patient group were significantly lower than those of the control group (P < .05), except for the ADC CST-ratio (P > .05). Regarding the DTT parameters of the CRT-ratio, the patient group FN value was significantly lower than that of the control group (P < .05), whereas the FA and ADC CRT-ratios did not show significant differences between the patient and control groups (P > .05). MAS scores showed a strong positive correlation with the ADC CRT-ratio (P < .05) and a moderate negative correlation with the FN CRT-ratio (P < .05). We observed that the injury severities of the CST and CRT were related to spasticity severity in chronic stroke patients; moreover, compared to the CST, CRT status was more closely related to spasticity severity.
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Affiliation(s)
- Min Jye Cho
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea
| | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, Dongnamgu, Cheonan, Republic of Korea
| | - Sung Jun Lee
- Department of Physical Therapy, College of Health Sciences, Dankook University, Dongnamgu, Cheonan, Republic of Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Namku, Taegu, Republic of Korea
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Abstract
Spasticity is characterized by an enhanced size and reduced threshold for activation of stretch reflexes and is associated with "positive signs" such as clonus and spasms, as well as "negative features" such as paresis and a loss of automatic postural responses. Spasticity develops over time after a lesion and can be associated with reduced speed of movement, cocontraction, abnormal synergies, and pain. Spasticity is caused by a combination of damage to descending tracts, reductions in inhibitory activity within spinal cord circuits, and adaptive changes within motoneurons. Increased tone, hypertonia, can also be caused by changes in passive stiffness due to, for example, increase in connective tissue and reduction in muscle fascicle length. Understanding the cause of hypertonia is important for determining the management strategy as nonneural, passive causes of stiffness will be more amenable to physical rather than pharmacological interventions. The management of spasticity is determined by the views and goals of the patient, family, and carers, which should be integral to the multidisciplinary assessment. An assessment, and treatment, of trigger factors such as infection and skin breakdown should be made especially in people with a recent change in tone. The choice of management strategies for an individual will vary depending on the severity of spasticity, the distribution of spasticity (i.e., whether it affects multiple muscle groups or is more prominent in one or two groups), the type of lesion, and the potential for recovery. Management options include physical therapy, oral agents; focal therapies such as botulinum injections; and peripheral nerve blocks. Intrathecal baclofen can lead to a reduction in required oral antispasticity medications. When spasticity is severe intrathecal phenol may be an option. Surgical interventions, largely used in the pediatric population, include muscle transfers and lengthening and selective dorsal root rhizotomy.
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Affiliation(s)
- Jonathan Marsden
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, United Kingdom.
| | - Valerie Stevenson
- Department of Therapies and Rehabilitation, National Hospital for Neurology and Neurosurgery UCLH, London, United Kingdom
| | - Louise Jarrett
- Department of Neurology, Royal Devon and Exeter Hospital, Exeter, United Kingdom
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Qin Y, Qiu S, Liu X, Xu S, Wang X, Guo X, Tang Y, Li H. Lesions causing post-stroke spasticity localize to a common brain network. Front Aging Neurosci 2022; 14:1011812. [PMID: 36389077 PMCID: PMC9642815 DOI: 10.3389/fnagi.2022.1011812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/07/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The efficacy of clinical interventions for post-stroke spasticity (PSS) has been consistently unsatisfactory, probably because lesions causing PSS may occur at different locations in the brain, leaving the neuroanatomical substrates of spasticity unclear. Here, we investigated whether heterogeneous lesions causing PSS were localized to a common brain network and then identified the key nodes in this network. Methods We used 32 cases of PSS and the Human Connectome dataset (n = 1,000), using a lesion network mapping method to identify the brain regions that were associated with each lesion in patients with PSS. Functional connectivity maps of all lesions were overlaid to identify common connectivity. Furthermore, a split-half replication method was used to evaluate reproducibility. Then, the lesion network mapping results were compared with those of patients with post-stroke non-spastic motor dysfunction (n = 29) to assess the specificity. Next, both sensitive and specific regions associated with PSS were identified using conjunction analyses, and the correlation between these regions and PSS was further explored by correlation analysis. Results The lesions in all patients with PSS were located in different cortical and subcortical locations. However, at least 93% of these lesions (29/32) had functional connectivity with the bilateral putamen and globus pallidus. These connections were highly repeatable and specific, as compared to those in non-spastic patients. In addition, the functional connectivity between lesions and bilateral putamen and globus pallidus in patients with PSS was positively correlated with the degree of spasticity. Conclusion We identified that lesions causing PSS were localized to a common functional connectivity network defined by connectivity to the bilateral putamen and globus pallidus. This network may best cover the locations of lesions causing PSS. The putamen and globus pallidus may be potential key regions in PSS. Our findings complement previous neuroimaging studies on PSS, contributing to identifying patients with stroke at high risk for spasticity at an early stage, and may point to PSS-specific brain stimulation targets.
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Affiliation(s)
- Yin Qin
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China
- Department of Rehabilitation Medicine, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Yin Qin,
| | - Shuting Qiu
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiaoying Liu
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China
- Department of Rehabilitation Medicine, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Shangwen Xu
- Department of Radiology, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China
| | - Xiaoyang Wang
- Department of Radiology, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China
| | - Xiaoping Guo
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China
- Department of Rehabilitation Medicine, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yuting Tang
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Hui Li
- Department of Radiology, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China
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11
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Lin BS, Lee IJ, Hsiao PC, Yang SY, Chen CY, Lee SH, Huang YF, Yen MH, Hu YH. Design of a Multi-Sensor System for Exploring the Relation between Finger Spasticity and Voluntary Movement in Patients with Stroke. SENSORS (BASEL, SWITZERLAND) 2022; 22:7212. [PMID: 36236314 PMCID: PMC9573204 DOI: 10.3390/s22197212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
A novel wearable multi-sensor data glove system is developed to explore the relation between finger spasticity and voluntary movement in patients with stroke. Many stroke patients suffer from finger spasticity, which is detrimental to their manual dexterity. Diagnosing and assessing the degrees of spasticity require neurological testing performed by trained professionals to estimate finger spasticity scores via the modified Ashworth scale (MAS). The proposed system offers an objective, quantitative solution to assess the finger spasticity of patients with stroke and complements the manual neurological test. In this work, the hardware and software components of this system are described. By requiring patients to perform five designated tasks, biomechanical measurements including linear and angular speed, acceleration, and pressure at every finger joint and upper limb are recorded, making up more than 1000 features for each task. We conducted a preliminary clinical test with 14 subjects using this system. Statistical analysis is performed on the acquired measurements to identify a small subset of features that are most likely to discriminate a healthy patient from patients suffering from finger spasticity. This encouraging result validates the feasibility of this proposed system to quantitatively and objectively assess finger spasticity.
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Affiliation(s)
- Bor-Shing Lin
- Department of Computer Science and Information Engineering, National Taipei University, New Taipei City 237303, Taiwan
| | - I-Jung Lee
- Department of Computer Science and Information Engineering, National Taipei University, New Taipei City 237303, Taiwan
- College of Electrical Engineering and Computer Science, National Taipei University, New Taipei City 237303, Taiwan
| | - Pei-Chi Hsiao
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan 71004, Taiwan
| | - Shu-Yu Yang
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan 71004, Taiwan
| | - Chen-Yu Chen
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan 71004, Taiwan
| | - Si-Huei Lee
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Yu-Fang Huang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Mao-Hsu Yen
- Department of Computer Science and Engineering, National Taiwan Ocean University, Keelung City 202301, Taiwan
| | - Yu Hen Hu
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, WI 53706, USA
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12
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van der Velden LL, Onneweer B, Haarman CJW, Benner JL, Roebroeck ME, Ribbers GM, Selles RW. Development of a single device to quantify motor impairments of the elbow: proof of concept. J Neuroeng Rehabil 2022; 19:77. [PMID: 35864498 PMCID: PMC9306071 DOI: 10.1186/s12984-022-01050-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background For patients with post-stroke upper limb impairments, the currently available clinical measurement instruments are inadequate for reliable quantification of multiple impairments, such as muscle weakness, abnormal synergy, changes in elastic joint properties and spasticity. Robotic devices to date have successfully achieved precise and accurate quantification but are often limited to the measurement of one or two impairments. Our primary aim is to develop a robotic device that can effectively quantify four main motor impairments of the elbow. Methods The robotic device, Shoulder Elbow Perturbator, is a one-degree-of-freedom device that can simultaneously manipulate the elbow joint and support the (partial) weight of the human arm. Upper limb impairments of the elbow were quantified based on four experiments on the paretic arm in ten stroke patients (mean age 65 ± 10 yrs, 9 males, post-stroke) and the non-dominant arm in 20 healthy controls (mean age 65 ± 14 yrs, 6 males). The maximum strength of elbow flexor and elbow extensor muscles was measured isometrically at 90-degree elbow flexion. The maximal active extension angle of the elbow was measured under different arm weight support levels to assess abnormal synergy. Torque resistance was analyzed during a slow (6°/s) passive elbow rotation, where the elbow moved from the maximal flexion to maximal extension angle and back, to assess elastic joint properties. The torque profile was evaluated during fast (100°/s) passive extension rotation of the elbow to estimate spasticity. Results The ten chronic stroke patients successfully completed the measurement protocol. The results showed impairment values outside the 10th and 90th percentile reference intervals of healthy controls. Individual patient profiles were determined and illustrated in a radar figure, to support clinicians in developing targeted treatment plans. Conclusion The Shoulder Elbow Perturbator can effectively quantify the four most important impairments of the elbow in stroke patients and distinguish impairment scores of patients from healthy controls. These results are promising for objective and complete quantification of motor impairments of the elbow and monitoring patient prognosis. Our newly developed Shoulder Elbow Perturbator can therefore in the future be employed to evaluate treatment effects by comparing pre- and post-treatment assessments. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01050-2.
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Affiliation(s)
- Levinia Lara van der Velden
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. .,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands.
| | - Bram Onneweer
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
| | | | - Joyce Lisanne Benner
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Marij Eugenie Roebroeck
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
| | - Gerard Maria Ribbers
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
| | - Ruud Willem Selles
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Westersingel 300, 3015 LJ, Rotterdam, The Netherlands
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13
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Chen Q, Shen W, Sun H, Zhang H, Liu C, Chen Z, Yu L, Cai X, Ke J, Li L, Zhang L, Fang Q. The effect of coupled inhibitory-facilitatory repetitive transcranial magnetic stimulation on shaping early reorganization of the motor network after stroke. Brain Res 2022; 1790:147959. [PMID: 35654120 DOI: 10.1016/j.brainres.2022.147959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Abstract
Neural plasticity is a major factor driving cortical reorganization after stroke. This study aimed to evaluate functional connectivity (FC) changes in the cortical motor network after coupled inhibitory-facilitatory repetitive transcranial magnetic stimulation (rTMS) treatment and to assess the correlation between FC changes and functional recovery, further characterizing the neural mechanisms underlying the beneficial effects of rTMS. We randomly divided 63 patients with acute stroke into four groups: (1) Group A received coupled inhibitory-facilitatory rTMS [1 Hz over the contralesional primary motor cortex (M1) and 10 Hz over ipsilesional M1]; (2) Group B received a contralesional sham stimulation and ipsilesional 10 Hz stimulation; (3) Group C received a contralesional 1 Hz rTMS and ipsilesional sham stimulation; and (4) Group D received bilateral sham stimulation only. Standardized rehabilitation therapy was performed immediately after rTMS, and each group was treated with their respective treatment modalities for 4 weeks. Twenty-four hours before and after the intervention, participants underwent resting-state functional magnetic resonance imaging. Additional functional assessments were conducted at baseline, after treatment, and at the 3 month follow-up. The rTMS treatment significantly changed the FCs of intra- and inter-hemispheric cortical motor networks in the rTMS groups (A and B) compared with the sham group (Group D). This effect was more pronounced in Group A, which displayed a changed FC between the contralesional postcentral gyrus and contralesional superior parietal gyrus, between the contralesional precentral gyrus and contralesional postcentral gyrus, and between the ipsilesional postcentral gyrus and contralesional superior parietal gyrus, when compared with Groups B and C. Importantly, FC changes were significantly correlated with improvement of motor function. In the early stages of ischemic stroke, coupled rTMS was more conducive to motor recovery by modulating the FCs of intra-hemispheric and inter-hemispheric motor networks. Our results suggested that FC changes were related to motor function recovery for early-stage cerebral stroke patients treated with coupled rTMS. These findings could help to understand the mechanism of coupled rTMS and further the use of this therapy as an adjunct rehabilitation technique in motor recovery.
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Affiliation(s)
- Qingmei Chen
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China; Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Wenjun Shen
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Haiwei Sun
- Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Hanjun Zhang
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Chuandao Liu
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Zhiguo Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Liqiang Yu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Xiuying Cai
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Jun Ke
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Li Li
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China.
| | - Lichi Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China.
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14
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van der Velden LL, de Koff MAC, Ribbers GM, Selles RW. The diagnostic levels of evidence of instrumented devices for measuring viscoelastic joint properties and spasticity; a systematic review. J Neuroeng Rehabil 2022; 19:16. [PMID: 35148805 PMCID: PMC8832664 DOI: 10.1186/s12984-022-00996-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many diagnostic robotic devices have been developed to quantify viscoelastic properties and spasticity of patients with upper motor neuron lesions. However, in clinical practice, subjective and nonvalid clinical scales are still commonly used. To understand the limited use of diagnostic robotic devices assessing viscoelastic joint properties and spasticity in clinical practice, we evaluate the diagnostic level of evidence of studies on these devices. METHOD A systematic literature review was performed using multiple databases. Two of the authors independently screened all articles. Studies investigating human subjects diagnosed with stroke or cerebral palsy, measured with a mechanical device to assess viscoelastic joint properties and/or spasticity of an extremity. All articles were assigned a diagnostic level of evidence, which was established with a classification strategy based on the number of participants and the design of the study, from a Level 0 (less than 10 subjects) to a Level IV, reporting the long-term clinical consequences in daily care. RESULTS Fifty-nine articles were included. Most studies measured the upper limb (64%) in stroke patients (81%). The highest level of evidence found was Level IIa (53%); these studies correlated the test values of the robotic device with a clinical test or within subgroups. Level 0 (30%) and Level I (17%; determining the range of values of the robotic test) were also common. None of the studies tested their device for diagnostic accuracy (Level III), clinical added value (Level IV). CONCLUSION The diagnostic evidence needed for implementing robotic devices in clinical practice is lacking. Our findings indicate that more effort should be invested in studying diagnostic accuracy (Level III) or added value for clinical care (Level IV); only these studies can provide clinicians with evidence that robotic devices have added value above the currently-used clinical scales.
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Affiliation(s)
- Levinia Lara van der Velden
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. .,Rijndam Rehabilitation, Rotterdam, The Netherlands.
| | | | - Gerard Maria Ribbers
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Ruud Willem Selles
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Rijndam Rehabilitation, Rotterdam, The Netherlands.,Department of Plastic and Reconstructive Surgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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15
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Pennati GV, Bergling H, Carment L, Borg J, Lindberg PG, Palmcrantz S. Effects of 60 Min Electrostimulation With the EXOPULSE Mollii Suit on Objective Signs of Spasticity. Front Neurol 2021; 12:706610. [PMID: 34721255 PMCID: PMC8554021 DOI: 10.3389/fneur.2021.706610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The EXOPULSE Mollii method is an innovative full-body suit approach for non-invasive electrical stimulation, primarily designed to reduce disabling spasticity and improve motor function through the mechanism of reciprocal inhibition. This study aimed to evaluate the effectiveness of one session of stimulation with the EXOPULSE Mollii suit at different stimulation frequencies on objective signs of spasticity and clinical measures, and the subjective perceptions of the intervention. Methods: Twenty patients in the chronic phase after stroke were enrolled in a cross-over, double-blind controlled study. Electrical stimulation delivered through EXOPULSE Mollii was applied for 60 min at two active frequencies (20 and 30 Hz) and in OFF-settings (placebo) in a randomized order, every second day. Spasticity was assessed with controlled-velocity passive muscle stretches using the NeuroFlexor hand and foot modules. Surface electromyography (EMG) for characterizing flexor carpi radialis, medial gastrocnemius, and soleus muscles activation, Modified Ashworth Scale and range of motion were used as complementary tests. Finally, a questionnaire was used to assess the participants' perceptions of using the EXOPULSE Mollii suit. Results: At group level, analyses showed no significant effect of stimulation at any frequency on NeuroFlexor neural component (NC) and EMG amplitude in the upper or lower extremities (p > 0.35). Nevertheless, the effect was highly variable at the individual level, with eight patients exhibiting reduced NC (>1 N) in the upper extremity after stimulation at 30 Hz, 5 at 20 Hz and 3 in OFF settings. All these patients presented severe spasticity at baseline, i.e., NC > 8 N. Modified Ashworth ratings of spasticity and range of motion did not change significantly after stimulation at any frequency. Finally, 75% of participants reported an overall feeling of well-being during stimulation, with 25% patients describing a muscle-relaxing effect on the affected hand and/or foot at both 20 and 30 Hz. Conclusions: The 60 min of electrical stimulation with EXOPULSE Mollii suit did not reduce spasticity consistently in the upper and lower extremities in the chronic phase after stroke. Findings suggest a need for further studies in patients with severe spasticity after stroke including repeated stimulation sessions. Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT04076878, identifier: NCT04076878.
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Affiliation(s)
- Gaia Valentina Pennati
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
| | - Hanna Bergling
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
| | - Loïc Carment
- Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université de Paris, Paris, France
| | - Jörgen Borg
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
| | - Påvel G Lindberg
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden.,Institut de Psychiatrie et Neurosciences de Paris, Inserm U1266, Université de Paris, Paris, France
| | - Susanne Palmcrantz
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
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16
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Zbytniewska M, Kanzler CM, Jordan L, Salzmann C, Liepert J, Lambercy O, Gassert R. Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke. J Neuroeng Rehabil 2021; 18:115. [PMID: 34271954 PMCID: PMC8283922 DOI: 10.1186/s12984-021-00904-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of sensorimotor function are impaired based on conventional clinical assessments that are often insensitive and subjective. In this work we propose and validate a set of robot-assisted assessments aiming at disentangling hand proprioceptive from motor impairments, and capturing their interrelation (sensorimotor impairments). Methods A battery of five complementary assessment tasks was implemented on a one degree-of-freedom end-effector robotic platform acting on the index finger metacarpophalangeal joint. Specifically, proprioceptive impairments were assessed using a position matching paradigm. Fast target reaching, range of motion and maximum fingertip force tasks characterized motor function deficits. Finally, sensorimotor impairments were assessed using a dexterous trajectory following task. Clinical feasibility (duration), reliability (intra-class correlation coefficient ICC, smallest real difference SRD) and validity (Kruskal-Wallis test, Spearman correlations \documentclass[12pt]{minimal}
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\begin{document}$$\rho$$\end{document}ρ with Fugl-Meyer Upper Limb Motor Assessment, kinesthetic Up-Down Test, Box & Block Test) of robotic tasks were evaluated with 36 sub-acute stroke subjects and 31 age-matched neurologically intact controls. Results Eighty-three percent of stroke survivors with varied impairment severity (mild to severe) could complete all robotic tasks (duration: <15 min per tested hand). Further, the study demonstrated good to excellent reliability of the robotic tasks in the stroke population (ICC>0.7, SRD<30%), as well as discriminant validity, as indicated by significant differences (p-value<0.001) between stroke and control subjects. Concurrent validity was shown through moderate to strong correlations (\documentclass[12pt]{minimal}
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\begin{document}$$\rho$$\end{document}ρ=0.4-0.8) between robotic outcome measures and clinical scales. Finally, robotic tasks targeting different deficits (motor, sensory) were not strongly correlated with each other (\documentclass[12pt]{minimal}
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\begin{document}$$\rho \le$$\end{document}ρ≤0.32, p-value>0.1), thereby presenting complementary information about a patient’s impairment profile. Conclusions The proposed robot-assisted assessments provide a clinically feasible, reliable, and valid approach to distinctly characterize impairments in hand proprioceptive and motor function, along with the interaction between the two. This opens new avenues to help unravel the contributions of unique aspects of sensorimotor function in post-stroke recovery, as well as to contribute to future developments towards personalized, assessment-driven therapies. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00904-5.
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Affiliation(s)
- Monika Zbytniewska
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Lisa Jordan
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Christian Salzmann
- Kliniken Schmieder Allensbach, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Joachim Liepert
- Kliniken Schmieder Allensbach, Zum Tafelholz 8, 78476, Allensbach, Germany
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.,Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
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17
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Plantin J, Verneau M, Godbolt AK, Pennati GV, Laurencikas E, Johansson B, Krumlinde-Sundholm L, Baron JC, Borg J, Lindberg PG. Recovery and Prediction of Bimanual Hand Use After Stroke. Neurology 2021; 97:e706-e719. [PMID: 34400568 PMCID: PMC8377875 DOI: 10.1212/wnl.0000000000012366] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 05/20/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine similarities and differences in key predictors of recovery of bimanual hand use and unimanual motor impairment after stroke. METHOD In this prospective longitudinal study, 89 patients with first-ever stroke with arm paresis were assessed at 3 weeks and 3 and 6 months after stroke onset. Bimanual activity performance was assessed with the Adult Assisting Hand Assessment Stroke (Ad-AHA), and unimanual motor impairment was assessed with the Fugl-Meyer Assessment (FMA). Candidate predictors included shoulder abduction and finger extension measured by the corresponding FMA items (FMA-SAFE; range 0-4) and sensory and cognitive impairment. MRI was used to measure weighted corticospinal tract lesion load (wCST-LL) and resting-state interhemispheric functional connectivity (FC). RESULTS Initial Ad-AHA performance was poor but improved over time in all (mild-severe) impairment subgroups. Ad-AHA correlated with FMA at each time point (r > 0.88, p < 0.001), and recovery trajectories were similar. In patients with moderate to severe initial FMA, FMA-SAFE score was the strongest predictor of Ad-AHA outcome (R 2 = 0.81) and degree of recovery (R 2 = 0.64). Two-point discrimination explained additional variance in Ad-AHA outcome (R 2 = 0.05). Repeated analyses without FMA-SAFE score identified wCST-LL and cognitive impairment as additional predictors. A wCST-LL >5.5 cm3 strongly predicted low to minimal FMA/Ad-AHA recovery (≤10 and 20 points respectively, specificity = 0.91). FC explained some additional variance to FMA-SAFE score only in unimanual recovery. CONCLUSION Although recovery of bimanual activity depends on the extent of corticospinal tract injury and initial sensory and cognitive impairments, FMA-SAFE score captures most of the variance explained by these mechanisms. FMA-SAFE score, a straightforward clinical measure, strongly predicts bimanual recovery. CLINICALTRIALSGOV IDENTIFIER NCT02878304. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that the FMA-SAFE score predicts bimanual recovery after stroke.
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Affiliation(s)
- Jeanette Plantin
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France.
| | - Marion Verneau
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Alison K Godbolt
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Gaia Valentina Pennati
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Evaldas Laurencikas
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Birgitta Johansson
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Lena Krumlinde-Sundholm
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Jean-Claude Baron
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Jörgen Borg
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
| | - Påvel G Lindberg
- From the Department of Clinical Sciences (J.P., A.K.G., G.V.P., E.L., J.B., P.G.L.), Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden; Institut de Psychiatrie et Neurosciences de Paris (M.V., J.-C.B., P.G.L.), Inserm U1266, Paris, France; Division of Rehabilitation Medicine (B.J.), Danderyd University Stockholm; Department of Women's and Children's Health (L.K.S.), Karolinska Institutet, Stockholm, Sweden; and Department of Neurology (J.-C.B.), Hôpital Sainte-Anne, Université de Paris, France
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18
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Wu Q, Ge Y, Ma D, Pang X, Cao Y, Zhang X, Pan Y, Zhang T, Dou W. Analysis of Prognostic Risk Factors Determining Poor Functional Recovery After Comprehensive Rehabilitation Including Motor-Imagery Brain-Computer Interface Training in Stroke Patients: A Prospective Study. Front Neurol 2021; 12:661816. [PMID: 34177767 PMCID: PMC8222567 DOI: 10.3389/fneur.2021.661816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Upper limb (UL) motor function recovery, especially distal function, is one of the main goals of stroke rehabilitation as this function is important to perform activities of daily living (ADL). The efficacy of the motor-imagery brain-computer interface (MI-BCI) has been demonstrated in patients with stroke. Most patients with stroke receive comprehensive rehabilitation, including MI-BCI and routine training. However, most aspects of MI-BCI training for patients with subacute stroke are based on routine training. Risk factors for inadequate distal UL functional recovery in these patients remain unclear; therefore, it is more realistic to explore the prognostic factors of this comprehensive treatment based on clinical practice. The present study aims to investigate the independent risk factors that might lead to inadequate distal UL functional recovery in patients with stroke after comprehensive rehabilitation including MI-BCI (CRIMI-BCI). Methods: This prospective study recruited 82 patients with stroke who underwent CRIMI-BCI. Motor-imagery brain-computer interface training was performed for 60 min per day, 5 days per week for 4 weeks. The primary outcome was improvement of the wrist and hand dimensionality of Fugl-Meyer Assessment (δFMA-WH). According to the improvement score, the patients were classified into the efficient group (EG, δFMA-WH > 2) and the inefficient group (IG, δFMA-WH ≤ 2). Binary logistic regression was used to analyze clinical and demographic data, including aphasia, spasticity of the affected hand [assessed by Modified Ashworth Scale (MAS-H)], initial UL function, age, gender, time since stroke (TSS), lesion hemisphere, and lesion location. Results: Seventy-three patients completed the study. After training, all patients showed significant improvement in FMA-UL (Z = 7.381, p = 0.000**), FMA-SE (Z = 7.336, p = 0.000**), and FMA-WH (Z = 6.568, p = 0.000**). There were 35 patients (47.9%) in the IG group and 38 patients (52.1%) in the EG group. Multivariate analysis revealed that presence of aphasia [odds ratio (OR) 4.617, 95% confidence interval (CI) 1.435-14.860; p < 0.05], initial FMA-UL score ≤ 30 (OR 5.158, 95% CI 1.150-23.132; p < 0.05), and MAS-H ≥ level I+ (OR 3.810, 95% CI 1.231-11.790; p < 0.05) were the risk factors for inadequate distal UL functional recovery in patients with stroke after CRIMI-BCI. Conclusion: We concluded that CRIMI-BCI improved UL function in stroke patients with varying effectiveness. Inferior initial UL function, significant hand spasticity, and presence of aphasia were identified as independent risk factors for inadequate distal UL functional recovery in stroke patients after CRIMI-BCI.
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Affiliation(s)
- Qiong Wu
- School of Rehabilitation Medicine, China Rehabilitation Research Center, Capital Medical University, Beijing, China.,Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yunxiang Ge
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, China
| | - Di Ma
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xue Pang
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yingyu Cao
- School of Mechanical Engineering, Beijing Institute of Petrochemical Technology, Beijing, China
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Yu Pan
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Tong Zhang
- School of Rehabilitation Medicine, China Rehabilitation Research Center, Capital Medical University, Beijing, China
| | - Weibei Dou
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing, China
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19
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Li S, Francisco GE, Rymer WZ. A New Definition of Poststroke Spasticity and the Interference of Spasticity With Motor Recovery From Acute to Chronic Stages. Neurorehabil Neural Repair 2021; 35:601-610. [PMID: 33978513 DOI: 10.1177/15459683211011214] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The relationship of poststroke spasticity and motor recovery can be confusing. "True" motor recovery refers to return of motor behaviors to prestroke state with the same end-effectors and temporo-spatial pattern. This requires neural recovery and repair, and presumably occurs mainly in the acute and subacute stages. However, according to the International Classification of Functioning, Disability and Health, motor recovery after stroke is also defined as "improvement in performance of functional tasks," i.e., functional recovery, which is mainly mediated by compensatory mechanisms. Therefore, stroke survivors can execute motor tasks in spite of disordered motor control and the presence of spasticity. Spasticity interferes with execution of normal motor behaviors ("true" motor recovery), throughout the evolution of stroke from acute to chronic stages. Spasticity reduction does not affect functional recovery in the acute and subacute stages; however, appropriate management of spasticity could lead to improvement of motor function, that is, functional recovery, during the chronic stage of stroke. We assert that spasticity results from upregulation of medial cortico-reticulo-spinal pathways that are disinhibited due to damage of the motor cortex or corticobulbar pathways. Spasticity emerges as a manifestation of maladaptive plasticity in the early stages of recovery and can persist into the chronic stage. It coexists and shares similar pathophysiological processes with related motor impairments, such as abnormal force control, muscle coactivation and motor synergies, and diffuse interlimb muscle activation. Accordingly, we propose a new definition of spasticity to better account for its pathophysiology and the complex nuances of different definitions of motor recovery.
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Affiliation(s)
- Sheng Li
- University of Texas Health Science Center-Houston, TX, USA.,TIRR Memorial Hermann, Houston, TX, USA
| | - Gerard E Francisco
- University of Texas Health Science Center-Houston, TX, USA.,TIRR Memorial Hermann, Houston, TX, USA.,World Federation of NeuroRehabilitation, North Shields, UK
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20
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Singh N, Saini M, Kumar N, Srivastava MVP, Mehndiratta A. Evidence of neuroplasticity with robotic hand exoskeleton for post-stroke rehabilitation: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:76. [PMID: 33957937 PMCID: PMC8101163 DOI: 10.1186/s12984-021-00867-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/20/2021] [Indexed: 01/09/2023] Open
Abstract
Background A novel electromechanical robotic-exoskeleton was designed in-house for the rehabilitation of wrist joint and Metacarpophalangeal (MCP) joint. Objective The objective was to compare the rehabilitation effectiveness (clinical-scales and neurophysiological-measures) of robotic-therapy training sessions with dose-matched conventional therapy in patients with stroke. Methods A pilot prospective parallel randomized controlled study at clinical settings was designed for patients with stroke within 2 years of chronicity. Patients were randomly assigned to receive an intervention of 20 sessions of 45 min each, five days a week for four weeks, in Robotic-therapy Group (RG) (n = 12) and conventional upper-limb rehabilitation in Control-Group (CG) (n = 11). We intended to evaluate the effects of a novel exoskeleton based therapy on the functional rehabilitation outcomes of upper-limb and cortical-excitability in patients with stroke as compared to the conventional-rehabilitation. Clinical-scales– Modified Ashworth Scale, Active Range of Motion, Barthel-Index, Brunnstrom-stage and Fugl-Meyer (FM) scale and neurophysiological measures of cortical-excitability (using Transcranial Magnetic Stimulation) –Motor Evoked Potential and Resting Motor threshold, were acquired pre- and post-therapy. Results No side effects were noticed in any of the patients. Both RG and CG showed significant (p < 0.05) improvement in all clinical motor-outcomes except Modified Ashworth Scale in CG. RG showed significantly (p < 0.05) higher improvement over CG in Modified Ashworth Scale, Active Range of Motion and Fugl-Meyer scale and FM Wrist-/Hand component. An increase in cortical-excitability in ipsilesional-hemisphere was found to be statistically significant (p < 0.05) in RG over CG, as indexed by a decrease in Resting Motor Threshold and increase in the amplitude of Motor Evoked Potential. No significant changes were shown by the contralesional-hemisphere. Interhemispheric RMT-asymmetry evidenced significant (p < 0.05) changes in RG over CG indicating increased cortical-excitability in ipsilesional-hemisphere along with interhemispheric changes. Conclusion Robotic-exoskeleton training showed improvement in motor outcomes and cortical-excitability in patients with stroke. Neurophysiological changes in RG could most likely be a consequence of plastic reorganization and use-dependent plasticity. Trial registry number: ISRCTN95291802 Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00867-7.
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Affiliation(s)
- Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All Indian Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology (IIT), New Delhi, India. .,Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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21
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Tonic stretch reflex threshold as a measure of spasticity after stroke: Reliability, minimal detectable change and responsiveness. Clin Neurophysiol 2021; 132:1226-1233. [PMID: 33867256 DOI: 10.1016/j.clinph.2021.02.390] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To determine inter-rater reliability, minimal detectable change and responsiveness of Tonic Stretch Reflex Threshold (TSRT) as a quantitative measure of elbow flexor spasticity. METHODS Elbow flexor spasticity was assessed in 55 patients with sub-acute stroke by determining TSRT, the angle of spasticity onset at rest (velocity = 0°/s). Elbow flexor muscles were stretched 20 times at different velocities. Dynamic stretch-reflex thresholds, the elbow angles corresponding to the onset of elbow flexor EMG at each velocity, were used for TSRT calculation. Spasticity was also measured with the Modified Ashworth Scale (MAS). In a sub-group of 44 subjects, TSRT and MAS were measured before and after two weeks of an upper-limb intervention. RESULTS The intraclass correlation coefficient was 0.65 and the 95% minimal detectable change was 32.4°. In the treated sub-group, TSRT, but not MAS significantly changed. TSRT effect size and standardized response mean were 0.40 and 0.35, respectively. Detection of clinically meaningful improvements in upper-limb motor impairment by TSRT change scores ranged from poor to excellent. CONCLUSIONS Evaluation of stroke-related elbow flexor spasticity by TSRT has good inter-rater reliability. Test responsiveness is low, but better than that of the MAS. SIGNIFICANCE TSRT may be used to complement current scales of spasticity quantification.
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22
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Zeng H, Chen J, Guo Y, Tan S. Prevalence and Risk Factors for Spasticity After Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2021; 11:616097. [PMID: 33551975 PMCID: PMC7855612 DOI: 10.3389/fneur.2020.616097] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Spasticity is a common sequela of stroke. The incidence of poststroke spasticity (PSS) has not been systematically reviewed in recent years, and some risk factors remain debated. This systematic review and meta-analysis was conducted to determine the prevalence and risk factors for PSS. Methods: We searched electronic databases (PubMed, Embase, Cochrane Library, CNKI, WANFANG and CBM) inception to May 12, 2020. Observational studies summarizing the incidence or risk factors for PSS were included. Only cohort studies were enrolled in meta-analysis. For risk factors examined in at least three different studies, we combined effects into odds ratios (OR) and 95% confidence intervals (CI). Results: One thousand four hundred sixty-seven studies were retrieved and 23 were involved in meta-analysis. The pooled prevalence of spasticity after stroke was 25.3% and that after the first-ever stroke was 26.7%. The incidence of spasticity after the first-ever stroke with paresis was 39.5%. The prevalence of disabling or severe spasticity (MAS ≥ 3) in stroke patients with paresis was 9.4% (95% CI 0.056-0.133), and severe spasticity was 10.3% (95% CI 0.058-0.149). Moderate to severe paresis (OR = 6.573, 95% CI 2.579-16.755, I 2 = 0.0%), hemorrhagic stroke (OR = 1.879, 95% CI 1.418-2.490, I 2 = 27.3%) and sensory disorder were risk factors for PSS. Conclusions: The incidence of PSS was significantly higher in stroke patients with paresis. Patients with moderate to severe paresis and sensory disorder should be closely followed up. The role of hemorrhagic stroke in predicting PSS remains to be further explored.
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Affiliation(s)
- Huangling Zeng
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Chen
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yang Guo
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Sheng Tan
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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23
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Sensorized Assessment of Dynamic Locomotor Imagery in People with Stroke and Healthy Subjects. SENSORS 2020; 20:s20164545. [PMID: 32823786 PMCID: PMC7472606 DOI: 10.3390/s20164545] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/29/2020] [Accepted: 08/11/2020] [Indexed: 12/14/2022]
Abstract
Dynamic motor imagery (dMI) is a motor imagery task associated with movements partially mimicking those mentally represented. As well as conventional motor imagery, dMI has been typically assessed by mental chronometry tasks. In this paper, an instrumented approach was proposed for quantifying the correspondence between upper and lower limb oscillatory movements performed on the spot during the dMI of walking vs. during actual walking. Magneto-inertial measurement units were used to measure limb swinging in three different groups: young adults, older adults and stroke patients. Participants were tested in four experimental conditions: (i) simple limb swinging; (ii) limb swinging while imagining to walk (dMI-task); (iii) mental chronometry task, without any movement (pure MI); (iv) actual level walking at comfortable speed. Limb swinging was characterized in terms of the angular velocity, frequency of oscillations and sinusoidal waveform. The dMI was effective at reproducing upper limb oscillations more similar to those occurring during walking for all the three groups, but some exceptions occurred for lower limbs. This finding could be related to the sensory feedback, stretch reflexes and ground reaction forces occurring for lower limbs and not for upper limbs during walking. In conclusion, the instrumented approach through wearable motion devices adds significant information to the current dMI approach, further supporting their applications in neurorehabilitation for monitoring imagery training protocols in patients with stroke.
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24
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Palmcrantz S, Pennati GV, Bergling H, Borg J. Feasibility and potential effects of using the electro-dress Mollii on spasticity and functioning in chronic stroke. J Neuroeng Rehabil 2020; 17:109. [PMID: 32778118 PMCID: PMC7419224 DOI: 10.1186/s12984-020-00740-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/29/2020] [Indexed: 12/21/2022] Open
Abstract
Background Spasticity after lesions of central motor pathways may be disabling and there is a need for new, cost-effective treatment methods. One novel approach is offered by the electro-dress Mollii®, primarily designed to enhance reciprocal inhibition of spastic muscles by multifocal, transcutaneous antagonist stimulation. Methods The Mollii® suit was set individually for 20 participants living with spasticity and hemiplegia after stroke and used in the home setting for 6 weeks. Usability and perceived effects were monitored by weekly telephone interviews. Outcome was assessed by use of the NeuroFlexor™ method for quantification of the neural component (NC) of resistance to passive stretch (spasticity), and the modified Ashworth scale (MAS) for total resistance, Fugl-Meyer Assessment of motor recovery for sensorimotor function in upper (FM-UE) and lower extremities (FM-LE), activity performance with the Action Research Arm Test (ARAT), Berg balance scale, 10 m and 6 min walk tests, and perceived functioning with the Stroke Impact Scale. Results Compliance was high (mean 19.25 of 21 sessions). Perceived positive effects were reported by 60% and most commonly related to decreased muscle tone (n = 9), improved gait pattern function (n = 7) and voluntary movement in the upper extremity (n = 6). On a group level, the NC decreased significantly in the wrist flexors of the affected hand (p = 0.023) and significant improvements according to FM-UE (p = 0.000) and FM-LE (p = 0.003) were seen after the intervention. No significant difference was detected with MAS or assessed activity performance, except for the ARAT (p = 0.000). FM-UE score change correlated significantly and fairly with the perceived effect in the upper extremity (r 0.498 p = 0.025) and in the corresponding analysis for the FM-LE and perceived effect in the lower extremity (r = 0.469 p = 0.037). Conclusion This study indicates that the Mollii® method is feasible when used in the home setting to decrease spasticity and improve sensorimotor function. The results may guide a larger controlled study combined with rehabilitation interventions to enhance effects on activity and participation domains. Trial registration NCT04076878. Registered 2 September 2019 - Retrospectively registered
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Affiliation(s)
- Susanne Palmcrantz
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Entrévagen 8, SE-182 88, Stockholm, Sweden.
| | - Gaia Valentina Pennati
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Entrévagen 8, SE-182 88, Stockholm, Sweden
| | - Hanna Bergling
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Entrévagen 8, SE-182 88, Stockholm, Sweden
| | - Jörgen Borg
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Entrévagen 8, SE-182 88, Stockholm, Sweden
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25
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Heung HL, Tang ZQ, Shi XQ, Tong KY, Li Z. Soft Rehabilitation Actuator With Integrated Post-stroke Finger Spasticity Evaluation. Front Bioeng Biotechnol 2020; 8:111. [PMID: 32181247 PMCID: PMC7059754 DOI: 10.3389/fbioe.2020.00111] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/04/2020] [Indexed: 11/13/2022] Open
Abstract
Strokes cause severe impairment of hand function because of the spasticity in the affected upper extremities. Proper spasticity evaluation is critical to facilitate neural plasticity for rehabilitation after stroke. However, existing methods for measuring spasticity, e.g. Modified Ashworth Scale (MAS), highly depends on clinicians' experiences, which are subjective and lacks quantitative details. Here, we introduce the first rehabilitation actuator that objectively reflects the condition of post-stroke finger spasticity. The actuator is 3D printed with soft materials. By considering the finger and the actuator together, the spasticity, i.e. stiffness, in finger is obtained from the pressure-angle relationship. The method is validated by simulations using finite element analysis (FEA) and experiments on mannequin fingers. Furthermore, it is examined on four stroke subjects and four healthy subjects. Results show the finger stiffness increases significantly from healthy subjects to stroke subjects, particularly those with high MAS score. For patients with the same MAS score, stiffness variation can be a few times. With this soft actuator, a hand rehabilitation robot that may tell the therapeutic progress during the rehabilitation training is readily available.
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Affiliation(s)
- Ho Lam Heung
- Department of Biomedical Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Zhi Qiang Tang
- Department of Biomedical Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Xiang Qian Shi
- Department of Biomedical Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kai Yu Tong
- Department of Biomedical Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Zheng Li
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
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